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Table 3 Individual beliefs influencing ANC uptake among adolescents

From: How can engagement of adolescents in antenatal care be enhanced? Learning from the perspectives of young mothers in Ghana and Tanzania

Construct

Definition and application to ANC uptake by adolescents

Illustrative Quote(s)

Perceived Susceptibility

One’s opinion about how vulnerable they are to a condition and its consequences (i.e. that adolescent women are more susceptible to obstetric complications than older women).

Individual is more likely to attend ANC if she believes the risk of experiencing illness or pregnancy/obstetric complications as a first time mother is high.

“She has to go so that she will be taken care of. Some of them [adolescent girls] they don’t have a strong waist [developed pelvis] to go through childbirth.” [GHA-6, R6]

PerceivedSeverity

One’s opinion of the seriousness of a condition and its consequences.

Individual is more likely to attend ANC if she believes that complications or illness during pregnancy, the risk of maternal and/or fetal illness or death is higher among adolescents.

“I was advised by different people, my friend, but also I thought because nowadays babies are born with disabilities, I better hurry to the clinic.” [TZA-3, R4]

Perceived Benefits

ANC uptake is more likely if one believes early and frequent ANC attendance will minimize risk and severity of illness/ complications.

Key benefits of ANC described by participants:

- Confirm pregnancy and ensure partner “takes responsibility”

- Blood test (HIV)

- To receive drugs if necessary

- To protect the welfare of the baby

“We go early because if we delay our boyfriend might deny the pregnancy… If you get impregnated by someone and the person refuses responsibility, a paternity test could be performed to know the real person responsible for the pregnancy. Otherwise you will be left with the responsibility and care of the pregnancy alone.” [GHA-6, R3]

“When you go there your blood is tested to know if you have any form of disease and you would then be given medication for any disease found in your blood.” [GHA-6, R1]

“We feel much healthier and stronger than if we do not go. I was given medicine at ANC.” [GHA-4, R1]

Perceived Barriers

One’s opinion of the tangible and psychological costs of the advised action. ANC uptake is more likely if perceived barriers are lower than perceived benefits.

1) Psychosocial costs:

- Shyness, embarrassment

- Fear of harsh treatment by nurses

- Fear of social discrimination

“I was scared of getting a full body check-up as I never had one before and I heard that they will completely undress me to be touched.” [TZA-3, R6]

“For instance you might be a student and when your classmates see you going they could make fun of you.” [GHA-2, R2]

 

2) Tangible costs:

- Long distance to walk

- Long wait times

- Cost of transport

- Confirmation of pregnancy (alerting others to status)

- Dislike for medications or services

- Having to leave school

“The distance from villages to the facility. We have to walk for a very long distance to reach the clinic and we don’t have transport.” [TZA-5, R1]

“Some of the medicines smell a lot and I don’t like that medicine” [GHA-4, R1]

Cues to Action

Strategies to activate “readiness”. ANC uptake is more likely if she receives reminders or public health messages promoting the use of ANC (media, campaigns, school, key social referents etc.)

1. Radio

2. Traditional birth attendant, or community health worker/mobilizer

3. mHealth notifications

“I receive text messages at times on the dos and don’ts of a pregnant woman. We also get phone calls at times.” [GHA-3, R4]